Effect of Chemical Debridement and Irrigant Activation on Endodontic Treatment Outcomes: An Updated Overview

Abstract

Chemical debridement is considered one of the most important steps during root canal treatment to target unreached areas and provide thorough disinfection of the canals. The efficiency of this step efficiency can be increased using different agitation and irrigation techniques/devices. This comprehensive review aimed to summarize the effect of various irrigant activation and agitation techniques/devices on endodontic treatment outcomes. Using mechanical active irrigation, which enables the activation or agitation of the irrigating solution, is beneficial in root canal treatment by increasing the efficiency of delivering the irrigant up to working length and ensuring isthmus cleanliness. However, considerable variation was noticed between the protocols used in each technique with a lack of well-designed randomized clinical trials to focus on the long-term outcome. Moreover, a low level of evidence was noticed regarding the effectiveness of certain activation techniques over others. Therefore, each study needs to be carefully weighed before using its results and embracing its conclusion. Future studies need to focus more on the antimicrobial effect of each technique and its effect on the healing of apical periodontitis. Also, recent advances, such as multisonic and laser activation, are promising tools that need more clinical investigations to show their efficiency.

Efficacy of Diode Laser Activated Irrigation (980 nm) and Passive Ultrasonic Irrigation in terms of Smear Layer Removal in Oval-Shaped Canals: A Comparative In-Vitro Study.

“…Hence, variable irrigant delivery systems and activation techniques were introduced to overcome especially the phenomenon of the vapor lock occurring at the apical portion (4,22) . To increase the efficacy of irrigating solutions in the apical area, acoustic and hydrodynamic properties of irrigants have been investigated (23); agitation with a laser or passive ultrasonic irrigation (PUI) has been utilized in endodontic therapy to decrease the amount of bacteria and alter the surface of the root canal (24) .…”

Herbal Agents versus Ethylene Diamine Tetra Acetic Acid on Removal of the Smear Layer—A Systematic Review of In Vitro Studies

“…In some instances, conventional syringe needle irrigation fails to reach the third apical intricacy of the root canal system, which warrants the use of irrigation activation to increase the flow and distribution. Activation of the irrigant causes acoustic streaming and cavitation, enabling the irrigant to reach the inaccessible areas of the canal [ 31 , 32 , 33 ]. All the included studies used S.E.M.…”

Antibacterial Effect of Matricaria chamomilla L. Extract Against Enterococcus faecalis

“…Root canal debridement is important for successful endodontic treatment. 1 Root canal irrigants should have the following attributes: low toxicity; antimicrobial effect; non-caustic to periodontal tissues; non-allergenic; and the ability to dissolve tissue and root canal debris, inactivate endotoxins, lubricate the canal, and remove the smear layer. 2 …”

“…Root canal debridement is important for successful endodontic treatment. 1 Root canal irrigants should have the following attributes: low toxicity; antimicrobial effect; non-caustic to periodontal tissues; non-allergenic; and the ability to dissolve tissue and root canal debris, inactivate endotoxins, lubricate the canal, and remove the smear layer. 2 Sodium hypochlorite, a root canal irrigant that is widely used in endodontic therapy, has antibacterial qualities and assists in mechanical root canal debridement and pulp dissolution.…”